The risk factors of operative failure in initial retina[ delachment surgery of 162 cases(169 eyes)were investigated with stepwise multivariate regression. The results demonstrated that the main causes of failure were the improper location of the buckle.new or previously up nidentified retinal breaks,meridian retinal folds on buckling ridge and presence of PVR. Fish-mouthing of retinal breaks,high myopia and choroidal detachment were foound to be related also with the effect of the operative treatment. （Chin J Ocul Fundus Dis,1994,10:203-206）
目的:观察显微镜直视下经外路手术治疗孔源性视网膜脱离的临床疗效。方法:孔源性视网膜脱离38例(38眼),术前在三面镜下检查裂孔位置、大小及脱离范围;在手术显微镜直视下行裂孔及变性区定位,放出视网膜下液,在裂孔及周围行视网膜冷凝,作硅胶垫压及环扎带。最后顶起硅胶垫压块,证实裂孔位于巩膜脊前坡上,视裂孔位置及眼压情况,玻璃体腔内注入C3F8。术后观察视力、眼压、葡萄膜反应及视网膜复位情况。结果:视网膜裂孔封闭36眼(94.74％),视网膜完全复位34眼(89.47％),视网膜下积液2眼(5.26％),于7～10d吸收。有２眼术后发现垫压嵴偏离视网膜裂孔,经再次手术调整后视网膜复位。术后视力提高28眼(73.68％)。结论:显微镜直视下经外路视网膜脱离手术视野清晰,操作简便,手术效果良好。
Objective To analyze the surgical feasibility, operative key points and visual function recovery of scleral buckling in patients with rhegmatogenous retinal detachment (RRD) with large or giant retinal hole. Methods RRD patients with large or giant retinal hole who underwent scleral buckling in Chengdu Aidi Eye Hospital between January 1, 2019 and December 31, 2020 were retrospectively selected. The general data, complications and postoperative recovery of the patients were observed. Results A total of 344 inpatients (351 eyes) underwent scleral buckling with RRD, including 43 patients (43 eyes) with retinal detachment of large or giant hole. Among the 43 patients, there were 30 males (30 eyes) and 13 females (13 eyes); 42 cases were successfully operated and got retinal reattachment, and 1 failed. One week later, the patient underwent vitrectomy combined with silicone oil tamponade, and got retinal reattachment. No serious complications occurred in the patients after operation. The visual acuity of most patients improved after surgery. ConclusionsScleral buckling is still an effective method to treat RRD. It is still suitable for more patients as long as they are carefully checked before operation and the operators master the key points of operation. At the same time, more patients’ vitreous bodies can be preserved, and the normal structure and intraocular environment of the eyeball can be maintained.
ObjectiveTo observe the effect of scleral buckling surgery (SB) in the treatment of rhegmatogenous retinal detachment (RRD) with subretinal hyperplasia (SRP). MethodsA retrospective case study. From January 2016 to December 2018, 31 patients with old RRD with SRP who were treated with SB in Department of Ophthalmology, Central Theater Command General Hospital were included in the study. There were 18 males with 20 eyes and 13 females with 15 eyes. Age was (26.5±8.7) years. The course of disease was (12.6±10.3) months. The best corrected visual acuity (BCVA) test was performed using the international standard visual acuity chart, which was converted to logarithm of the minimum angle of resolution (logMAR) visual acuity at the time of recording. Retinal detachment ranges ≤2, ＞2-＜3, ≥3 quadrants were 10 (28.6%, 10/35), 20 (57.1%, 20/35), and 5 (14.3%, 5/35) eyes, respectively. All affected eyes were treated with SB. Among them, 22 eyes (63.0%, 22/35) underwent local Scleral buckling, 11 eyes (31.4%, 11/35) underwent combined encircling buckle, and 2 eyes (5.7%, 2/35) underwent encircling buckle alone. Subretinal fluid drainage was performed in 33 eyes (94.3%, 33/35). The mean follow-up time was 18.2 months. Relevant examinations were performed with the same equipment and methods before operation to observe BCVA and retinal reattachment. Paired sample t test was used to compare logMAR BCVA before and after operation. ResultsAt the last follow-up, retinal reattachment occurred in 32 eyes (91.4%, 32/35) of 35 eyes. The retina did not reset in 3 eyes (8.6%, 3/35). logMAR BCVA of affected eye was 0.67±0.29 (finger counting-1.0). The difference of logMAR BCVA before and after operation was statistically significant (t=5.133, P=0.036). In 35 eyes, visual acuity improved, stabilized and decreased in 19 (54.3%, 19/35), 13 (37.1%, 13/35) and 3 (8.6%, 3/35) eyes, respectively. Ten months after surgery, the silicone tape was exposed and infected 1 eye. After the silicone tape was removed, the infection subsided and the retina was in place. There were no intraocular hemorrhage, vitreoretinal impaction, endophthalmitis and other complications during and after operation. ConclusionSB treatment of RRD with SRP can achieve good retinal reposition and improve visual acuity to some extent.
ObjectiveTo systematically review the efficacy of preoperative corticosteroids use as an adjunctive treatment for rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD). MethodsA evidence-based medicine study. The National Library of Medicine's PubMed, Web of Science, CNKI, and WanFang database were searched. Clinical controlled studies were selected the study object was RRDCD patients and the interventions were preoperative corticosteroids used as an adjunctive treatment. The search was conducted from January 2000 to January 2022. Duplicated, incomplete, or irrelevant articles were excluded. The conventional meta-analysis was used to evaluate the efficacy of corticosteroids used before surgery. The network meta-analysis was used to directly or indirectly compare the efficacy of oral corticosteroids or intravenous dexamethasone, peribulbar injection of glucocorticoids, prednisolone acetate eye-drops, intravitreal injection of triamcinolone acetonide (TA) and posterior sub-tenon injection of triamcinolone acetonide. Publication bias was evaluated by funnel plot. ResultsAccording to the search strategy, 43 articles were initially retrieved, and 929 eyes of 13 articles were finally included for analysis; 6 and 10 articles were included in the traditional meta-analysis and the network meta-analysis. Among the 6 studies included in the conventional meta-analysis, 5 studies were retrospective and 1 study was a randomized controlled trial, involving a total of 575 eyes. The analysis results showed that there was no significant difference in the primary retinal reattachment rate between the corticosteroids group and the control group [odds ratio (OR)= 1.53, 95% confidence interval (CI) 0.67-3.53, P=0.314]. Among the 10 studies included in the network meta-analysis, 7 studies were retrospective trials, 2 studies were randomized controlled trials, and 1 study was prospective trial, involving a total of 575 eyes. The analysis results showed that there were significant differences in the primary retinal reattachment rate between the triamcinolone acetonide intravitreal injection group and the no corticosteroid treatment group (OR=4.09, 95%CI 1.06-15.79). Sub-tenon injection triamcinolone acetonide had a higher incidence rate of ocular hypertension than oral glucocorticoid or intravenous dexamethasone (OR= 4.47, 95%CI 1.42-14.13). ConclusionsTriamcinolone acetonide intravitreal injection before surgery can improve the primary retinal reattachment rate in RRDCD patients. Patients with the posterior sub-tenon injection of triamcinolone acetonide should be alert to elevated intraocular pressure.
ObjectiveTo observe the expression levels of related cytokines in the vitreous humor of eyes with rhegmatogenous retinal detachment (RRD) associated with lattice degeneration (LD). MethodsA clinical observational study. From May 2022 to February 2023, 43 patients of 43 eyes diagnosed with RRD, with or without accompanying LD, who underwent their first pars plana vitrectomy (PPV) at Zhongda Hospital Southeast University and The Affiliated Eye Hospital of Nanjing Medical University were included in the study. The patients were divided into two groups: RRD with LD (LD group), consisting of 27 patients with 27 eyes, and RRD without LD (Non-LD group), consisting of 16 patients with 16 eyes. Additionally, 6 patients (6 eyes) with idiopathic macular holes and 4 patients (4 eyes) with idiopathic epiretinal membranes during the same period were selected as the control group. Before initiating PPV and without intraocular perfusion, a 0.5 ml sample of undiluted vitreous fluid from the central portion was excised and aspirated. The concentrations of monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1 alpha (MIP)-1α, MIP-1β, interferon-γ- inducible protein 10 (IP-10), interleukin-6 (IL-6), IL-8, macrophage migration inhibitory factor (MIF), tumor necrosis factor-alpha-α, interferon-γ, intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1, platelet endothelial cell adhesion molecule 1 (PECAM-1), placental growth factor (PLGF) and vascular endothelial growth factor (VEGF) in the vitreous fluid were quantitatively measured using the Luminex high-throughput multiplex assay technology. The comparison of cytokine expression levels between groups was performed using the Kruskal-Wallis rank sum test, with significance levels for post-hoc pairwise comparisons adjusted by DSCF methods. ResultsThe eyes of the patients in the LD group, Non-LD group, and control group showed statistically significant differences (P＜0.05) in the concentrations of IL-6 (H=14.400), IL-8 (H=13.610), MCP-1 (H=12.050), VEGF (H=9.920), MIP-1α (H=6.620), IP-10 (H=7.780), MIF (H=12.920), PECAM-1 (H=9.990), ICAM-1 (H=8.070), and PLGF (H=16.850). Upon pairwise comparison between groups, the vitreous fluid concentrations of IL-6, IL-8, and PLGF in the LD group were found to be significantly higher than those in the Non-LD group (P＜0.05). ConclusionThe expression levels of IL-6, IL-8, and PLGF are elevated in the vitreous fluid of eyes with RRD accompanied by LD.
ObjectiveTo observe the proteomic changes in vitreous fluid samples from patients with rhegmatogenous retinal detachment combined with choroidal detachment (RRDCD). MethodsA prospective cross-sectional clinical study. Vitreous fluid samples were collected from 35 patients with RRDCD (RRDCD group) and 40 patients with rhegmatogenous retinal detachment (RRD group) who were diagnosed at Wuhan Aier Eye Hospital between November 2021 and December 2023. Prior to vitrectomy, 0.3-0.5 ml of vitreous fluid was collected from the affected eyes. Differentially expressed proteins were analyzed using Data-Independent Acquisition (DIA). Three of these proteins were randomly selected for validation using enzyme-linked immunosorbent assay (ELISA). Bioinformatics analyses, including gene ontology functional enrichment and kyoto encyclopedia of genes and genomes pathway enrichment, were performed to explore the functions of the differentially expressed proteins. ResultsSignificant differences were observed between the RRDCD and RRD groups in intraocular pressure (t=－12.795), the number of retinal tears (t=4.601), the extent of retinal detachment (χ2=39.642), axial length (t=0.840), postoperative proliferative vitreoretinopathy incidence (χ2=4.730), single-surgery reattachment rate (χ2=7.717), and best-corrected visual acuity (t=7.033) at 6 months postoperatively (P＜0.05). A total of 237 differentially expressed proteins were identified between the RRDCD and RRD groups, with 63 upregulated and 174 downregulated. These proteins were involved in pathways such as extracellular matrix-receptor interaction, complement activation, coagulation, and lysosomal pathways. ELISA validation results showed that the expression trends of the three selected proteins in the RRDCD and RRD groups were consistent with the DIA proteomic analysis. Compared to the RRD group, proteins such as fibrin, coagulation factors, cathepsins, and trypsin inhibitors were significantly upregulated in the RRDCD group.ConclusionsThe protein expression profile in vitreous fluid samples from RRDCD patients show significant alterations compared to the RRD group. These differential changes suggest that RRDCD is closely associated with complement and coagulation cascade activation, lysosomal pathways, and extracellular matrix remodeling.